+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Implications of Medicare's prospective payment system for the provision of uncompensated hospital care



Implications of Medicare's prospective payment system for the provision of uncompensated hospital care



Inquiry 23(4): 371-381



Medicare's prospective payment system (PPS) has the potential to directly affect the level of uncompensated care provided by hospitals. Hospitals that realize deficits for their Medicare patients may have to limit provision of uncompensated care whereas those that realize surpluses may provide more free care. This paper measures these potential effects by combining simulation estimates of PPS's impact on the revenues of high-volume providers of uncompensated care with regression estimates of the impact of changes in hospitals' financial margins on uncompensated care. Our analysis indicates that PPS may result in a slight increase in the aggregate amount of uncompensated care provided by hospitals, but that it will likely reduce care for the indigent in some localities. Potential modifications to PPS--particularly those that limit price increases or reduce the indirect teaching adjustment--could eventually reduce any of the initial positive effects on uncompensated care and enhance the negative effects.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 040376293

Download citation: RISBibTeXText

PMID: 2947858

DOI: 10.2307/29771826


Related references

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR). Federal Register 82(155): 37990-38589, 2017

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Federal Register 78(160): 50495-51040, 2013

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals' FTE resident caps for graduate medical education payment. Final rules. Federal Register 76(160): 51476-51846, 2011

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates. Federal Register 79(163): 49853-50536, 2014

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment. Federal Register 80(158): 49325-49886, 2015

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment. Federal Register 81(162): 56761-57345, 2016

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule. Federal Register 77(170): 53257-53750, 2012

Medicare program; changes to the hospital inpatient prospective payment system for acute care hospitals and fiscal year 2010 rates; and changes to the long-term care hospital prospective payment system and rate years 2010 and 2009 rates. Final rules and interim final rule with comment period. Federal Register 74(165): 43753-44236, 2009

Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule. Federal Register 71(226): 67959-68401, 2006

Medicare program; FY 2014 inpatient prospective payment systems: changes to certain cost reporting procedures related to disproportionate share hospital uncompensated care payments. Interim final rule with comment period. Federal Register 78(192): 61191-7, 2013

Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period. Federal Register 75(157): 50041-50681, 2010

Medicaid Disproportionate Share Hospital payment: how does it impact hospitals' provision of uncompensated care?. Inquiry 49(3): 254-267, 2012

Medicaid Disproportionate Share Hospital Payment: How Does It Impact Hospitals' Provision of Uncompensated Care?. Inquiry - Journal of Health Care Organization, Provision & Financing 49(3): 254-267, 2012

Growth in Medicare's hospital outpatient care: implications for prospective payment. Inquiry 32(2): 155-163, 1995

Hospital outpatient prospective payment under Medicare: understanding the system and its implications. Radiology 225(1): 13-19, 2002